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alcohol dependence

physical dependence:

  • “DT - level” requires:
    • blood concentration of ethanol > 100mg/dl most of waking day (intake 200-350g/d) for period of 1wk, or,
    • 4-7wks at levels nearer 100mg/dl;
    • ie. 1-1.5 bottles spirits, 3-5 bottles wine, or 5-9 litres beer each day)

alcohol dependence indicators:

  • having an early morning drink or 'eye opener'
  • exceeding NHMRC recommendations (pdf) for low risk, sensible drinking:
    • short-term:
      • men - 6 std drinks in one day, < 4 days per wk
      • women - 4 std drinks in one day, < 4 days per wk
    • long term:
      • men - 4 std drinks in one day, up to 28 per wk
      • women - 2 std drinks in one day, up to 14 per wk
  • no alcohol free days in the week
  • reduced social or occupational activities as a result of time spent either obtaining alcohol or recovering from its effects

withdrawal syndrome:


  • headache, vertigo, N, pallor, sweating, nystagmus, tachycardia;
  • responds to more ethanol → use is 1st sign of physical depend.
  • ? due to:
    • persistence of mechanisms → ac. P/D tolerance;
    • dehydration & electrolyte disturbance;
    • hypoglycaemia, lactic acidaemia;

Full Syndrome:

1st phase:

  • in mild-mod. dependence;
  • onset 8-24hrs →
    • nervousness, apprehension, muscle weakness
    • tremor, nausea, retching, anorexia, “butterflies in stomach”.

2nd phase:

  • in mod-severe dependence;
  • abstinence continued → develops 12-24hrs in 1st phase
  • marked tremor, muscle cramps, incr. body temp., sweating, diarrhoea, nausea, vomiting, tachycardia, incr. BP, incr. incr. agitation.
  • insomnia - only brief completely REM-sleep full of nightmares, hyperpnoea → initial metab. acidosis → resp. alkalosis

3rd phase: delirium tremens

  • begins 2-4 days after onset abstinence with persisting phase 1&2 S/S;
  • verbalised delusions (muttering delirium), confusion, disorientation, marked agitation, panic reactions, paranoid reactions + auditory hallucinations
  • hyperacusis may precede auditory hallucinations;
  • tactile & visual (often terrifying) hallucinations;
  • tremor ++++ may be interspersed with clonic jerks → petit mal → grand mal → status;
  • Untreated mortality 15-50% assoc. with convulsions, hyperthermia, coma, shock;
  • If survives, lasts up to 3 days then deep sleep & awakes calm & lucid but full recovery with return to REM sleep in normal proportion takes about 2 weeks from onset abstinence, but delayed if nutritional/organic disorders incurred during the ethanol use;
ethanol_dependence.txt · Last modified: 2014/01/10 00:12 by

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